Including Parents in the Treatment Of Pediatric Complex Regional Pain Syndrome

Shayleigh K. Dickson, MSN, APN, CPNPAC, CPN

Disclosures

Pediatr Nurs. 2017;43(1):16-21. 

In This Article

Abstract and Introduction

Abstract

Complex regional pain syndrome (CRPS) is a clinically diagnosed chronic pain syndrome characterized by severe pain and functional disability following a minor injury. The affected limb often has evidence of changes in sensory, vasomotor, sudomotor/edema, and/or motor/tropic function. The diagnosis of CRPS in the pediatric population is increasingly common, especially among female adolescents. The pain experience of adolescents with CRPS is best understood using the biopsychosocial framework, and the most effective treatment programs target biological, psychological, and social factors. Treatment for CRPS is multidisciplinary and typically includes physical therapy, occupational therapy, and psychology. The parent-child dyad that develops when the child has CRPS is complex and characterized by significant psychological distress, ineffective parenting, and poor coping. The purpose of this article is to describe the role of parents in the treatment of adolescents with CRPS. To promote successful remission from pain and restoration of functional ability, parents should be included in treatment programs. Nurses caring for adolescents with CRPS can assist parents in developing adaptive parenting skills.

Introduction

Pain is a subjective experience, and nurses are trained that pain is "whatever the experiencing person says it is, existing whenever the experiencing person say it does" (McCaffery, 1968, p. 95). When a patient presents with complex regional pain syndrome (CRPS), the pain can be difficult for both clinicians and families to understand, first because of the unusual symptomatology, and second because CRPS does not respond well to medication. Patients with CRPS have pain that is disproportionate to the inciting injury and experience a significant amount of resultant functional disability (Stanton-Hicks, 2010; Tan, Zijlstra, Essink, Goris, & Severijnen, 2008). Treatment consists of physical and occupational therapy to train the patient to use the affected limb, desensitize the painful area, and regain functional skills related to activities of daily living. Additionally, psychotherapy is used to target stress that can exacerbate the symptoms or complicate achieving remission from the pain. This is dissimilar from the management of acute pain, which typically includes medications prescribed in an escalating fashion from over-the-counter agents, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), to prescribed medications, such as narcotics, muscle relaxants, and corticosteroids. Non-pharmacological treatments are also employed when managing acute pain, including heat, ice, immobilization, distraction, and relaxation.

CRPS in the pediatric population has been described in the literature for the past 30 years. Despite this relatively recent identification of CRPS in pediatrics, strong evidence supports that psychological and social factors influence the child's experience with a diagnosis of CRPS. Further, patients' symptoms occur within the context of their environment, which is largely influenced by family dynamics, parental relationships, and familial stress. Although characteristics of the family of a child with CRPS are well documented, the literature fails to provide a clear description of the role of parents within the context of treatment. The aim of this article is to describe the role of parents in the treatment of patients with CRPS. In doing so, characteristics of CRPS and its treatment modalities will be described. Nurses may use this information to provide family-centered care to this unique population of adolescents.

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